|
CV Angiogram Carotid Cerebral Right
|
Facility
|
IP
|
$5,687.00
|
|
| Hospital Charge Code |
2980123
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,786.63 |
| Max. Negotiated Rate |
$5,232.04 |
| Rate for Payer: Aetna Commercial |
$5,118.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,890.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,014.11
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,232.04
|
| Rate for Payer: Health EOS Commercial |
$5,061.43
|
| Rate for Payer: HFN Commercial |
$5,232.04
|
| Rate for Payer: Multiplan Commercial |
$4,549.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,232.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,786.63
|
| Rate for Payer: Quartz Commercial |
$3,412.20
|
| Rate for Payer: WEA Trust Commercial |
$3,127.85
|
| Rate for Payer: WPS Commercial |
$4,212.36
|
|
|
CV Angiogram Carotid Cervical Bilateral
|
Facility
|
OP
|
$6,158.00
|
|
| Hospital Charge Code |
1412882
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$24,632.00 |
| Rate for Payer: Aetna Commercial |
$5,542.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,295.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,724.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,002.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,079.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,955.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,263.74
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,665.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,446.02
|
| Rate for Payer: Health EOS Commercial |
$5,480.62
|
| Rate for Payer: HFN Commercial |
$5,665.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,618.50
|
| Rate for Payer: Multiplan Commercial |
$4,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,665.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,017.42
|
| Rate for Payer: Quartz Commercial |
$4,002.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,694.80
|
| Rate for Payer: The Alliance Commercial |
$24,632.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,386.90
|
| Rate for Payer: WPS Commercial |
$4,561.23
|
|
|
CV Angiogram Carotid Cervical Bilateral
|
Facility
|
IP
|
$6,158.00
|
|
| Hospital Charge Code |
1412882
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,017.42 |
| Max. Negotiated Rate |
$5,665.36 |
| Rate for Payer: Aetna Commercial |
$5,542.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,295.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,263.74
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,665.36
|
| Rate for Payer: Health EOS Commercial |
$5,480.62
|
| Rate for Payer: HFN Commercial |
$5,665.36
|
| Rate for Payer: Multiplan Commercial |
$4,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,665.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,017.42
|
| Rate for Payer: Quartz Commercial |
$3,694.80
|
| Rate for Payer: WEA Trust Commercial |
$3,386.90
|
| Rate for Payer: WPS Commercial |
$4,561.23
|
|
|
CV Angiogram Carotid Cervical Bilateral
|
Professional
|
Both
|
$6,158.00
|
|
| Hospital Charge Code |
1412882
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,709.52 |
| Max. Negotiated Rate |
$5,850.10 |
| Rate for Payer: Aetna Commercial |
$5,850.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,295.88
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,850.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,079.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,694.80
|
| Rate for Payer: Health EOS Commercial |
$5,603.78
|
| Rate for Payer: HFN Commercial |
$5,850.10
|
| Rate for Payer: Multiplan Commercial |
$4,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,850.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,709.52
|
| Rate for Payer: Quartz Commercial |
$3,510.06
|
| Rate for Payer: The Alliance Commercial |
$3,079.00
|
| Rate for Payer: WEA Trust Commercial |
$3,386.90
|
| Rate for Payer: WPS Commercial |
$4,561.23
|
|
|
CV Angiogram Carotid Cervical Left
|
Facility
|
IP
|
$6,616.00
|
|
| Hospital Charge Code |
1412884
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,241.84 |
| Max. Negotiated Rate |
$6,086.72 |
| Rate for Payer: Aetna Commercial |
$5,954.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,506.48
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,086.72
|
| Rate for Payer: Health EOS Commercial |
$5,888.24
|
| Rate for Payer: HFN Commercial |
$6,086.72
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,086.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,241.84
|
| Rate for Payer: Quartz Commercial |
$3,969.60
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cervical Left
|
Professional
|
Both
|
$6,616.00
|
|
| Hospital Charge Code |
1412884
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,911.04 |
| Max. Negotiated Rate |
$6,285.20 |
| Rate for Payer: Aetna Commercial |
$6,285.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,285.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,308.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,969.60
|
| Rate for Payer: Health EOS Commercial |
$6,020.56
|
| Rate for Payer: HFN Commercial |
$6,285.20
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,285.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,911.04
|
| Rate for Payer: Quartz Commercial |
$3,771.12
|
| Rate for Payer: The Alliance Commercial |
$3,308.00
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cervical Left
|
Facility
|
OP
|
$6,616.00
|
|
| Hospital Charge Code |
1412884
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$26,464.00 |
| Rate for Payer: Aetna Commercial |
$5,954.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,852.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,300.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,308.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,175.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,506.48
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,086.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,702.31
|
| Rate for Payer: Health EOS Commercial |
$5,888.24
|
| Rate for Payer: HFN Commercial |
$6,086.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,962.00
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,086.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,241.84
|
| Rate for Payer: Quartz Commercial |
$4,300.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,969.60
|
| Rate for Payer: The Alliance Commercial |
$26,464.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cervical Right
|
Professional
|
Both
|
$6,616.00
|
|
| Hospital Charge Code |
1412886
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,911.04 |
| Max. Negotiated Rate |
$6,285.20 |
| Rate for Payer: Aetna Commercial |
$6,285.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,285.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,308.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,969.60
|
| Rate for Payer: Health EOS Commercial |
$6,020.56
|
| Rate for Payer: HFN Commercial |
$6,285.20
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,285.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,911.04
|
| Rate for Payer: Quartz Commercial |
$3,771.12
|
| Rate for Payer: The Alliance Commercial |
$3,308.00
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cervical Right
|
Facility
|
OP
|
$6,616.00
|
|
| Hospital Charge Code |
1412886
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$26,464.00 |
| Rate for Payer: Aetna Commercial |
$5,954.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,852.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,300.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,308.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,175.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,506.48
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,086.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,702.31
|
| Rate for Payer: Health EOS Commercial |
$5,888.24
|
| Rate for Payer: HFN Commercial |
$6,086.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,962.00
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,086.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,241.84
|
| Rate for Payer: Quartz Commercial |
$4,300.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,969.60
|
| Rate for Payer: The Alliance Commercial |
$26,464.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cervical Right
|
Facility
|
IP
|
$6,158.00
|
|
| Hospital Charge Code |
2980124
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,017.42 |
| Max. Negotiated Rate |
$5,665.36 |
| Rate for Payer: Aetna Commercial |
$5,542.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,295.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,263.74
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,665.36
|
| Rate for Payer: Health EOS Commercial |
$5,480.62
|
| Rate for Payer: HFN Commercial |
$5,665.36
|
| Rate for Payer: Multiplan Commercial |
$4,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,665.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,017.42
|
| Rate for Payer: Quartz Commercial |
$3,694.80
|
| Rate for Payer: WEA Trust Commercial |
$3,386.90
|
| Rate for Payer: WPS Commercial |
$4,561.23
|
|
|
CV Angiogram Carotid Cervical Right
|
Facility
|
IP
|
$6,616.00
|
|
| Hospital Charge Code |
1412886
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,241.84 |
| Max. Negotiated Rate |
$6,086.72 |
| Rate for Payer: Aetna Commercial |
$5,954.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,506.48
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,086.72
|
| Rate for Payer: Health EOS Commercial |
$5,888.24
|
| Rate for Payer: HFN Commercial |
$6,086.72
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,086.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,241.84
|
| Rate for Payer: Quartz Commercial |
$3,969.60
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cervical Right
|
Facility
|
OP
|
$6,158.00
|
|
| Hospital Charge Code |
2980124
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$24,632.00 |
| Rate for Payer: Aetna Commercial |
$5,542.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,295.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,724.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,002.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,079.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,955.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,263.74
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,665.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,446.02
|
| Rate for Payer: Health EOS Commercial |
$5,480.62
|
| Rate for Payer: HFN Commercial |
$5,665.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,618.50
|
| Rate for Payer: Multiplan Commercial |
$4,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,665.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,017.42
|
| Rate for Payer: Quartz Commercial |
$4,002.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,694.80
|
| Rate for Payer: The Alliance Commercial |
$24,632.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,386.90
|
| Rate for Payer: WPS Commercial |
$4,561.23
|
|
|
CV Angiogram Carotid Cervical Right
|
Professional
|
Both
|
$6,158.00
|
|
| Hospital Charge Code |
2980124
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,709.52 |
| Max. Negotiated Rate |
$5,850.10 |
| Rate for Payer: Aetna Commercial |
$5,850.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,295.88
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,850.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,079.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,694.80
|
| Rate for Payer: Health EOS Commercial |
$5,603.78
|
| Rate for Payer: HFN Commercial |
$5,850.10
|
| Rate for Payer: Multiplan Commercial |
$4,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,850.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,709.52
|
| Rate for Payer: Quartz Commercial |
$3,510.06
|
| Rate for Payer: The Alliance Commercial |
$3,079.00
|
| Rate for Payer: WEA Trust Commercial |
$3,386.90
|
| Rate for Payer: WPS Commercial |
$4,561.23
|
|
|
CV Angiogram Extremity Bilateral
|
Facility
|
OP
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 LT
|
| Hospital Charge Code |
1412892
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$42,120.00 |
| Rate for Payer: Aetna Commercial |
$9,477.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,055.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,948.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,580.90
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cigna Commercial |
$9,687.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,892.59
|
| Rate for Payer: Health EOS Commercial |
$9,371.70
|
| Rate for Payer: HFN Commercial |
$9,687.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,897.50
|
| Rate for Payer: Multiplan Commercial |
$8,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,318.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,687.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,159.70
|
| Rate for Payer: Quartz Commercial |
$6,844.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,318.00
|
| Rate for Payer: The Alliance Commercial |
$42,120.00
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$5,791.50
|
| Rate for Payer: WPS Commercial |
$7,799.57
|
|
|
CV Angiogram Extremity Bilateral
|
Professional
|
Both
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 LT
|
| Hospital Charge Code |
1412892
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4,633.20 |
| Max. Negotiated Rate |
$10,003.50 |
| Rate for Payer: Aetna Commercial |
$10,003.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,055.80
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cigna Commercial |
$10,003.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,318.00
|
| Rate for Payer: Health EOS Commercial |
$9,582.30
|
| Rate for Payer: HFN Commercial |
$10,003.50
|
| Rate for Payer: Multiplan Commercial |
$8,424.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,003.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,633.20
|
| Rate for Payer: Quartz Commercial |
$6,002.10
|
| Rate for Payer: The Alliance Commercial |
$5,265.00
|
| Rate for Payer: WEA Trust Commercial |
$5,791.50
|
| Rate for Payer: WPS Commercial |
$7,799.57
|
|
|
CV Angiogram Extremity Bilateral
|
Facility
|
IP
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 LT
|
| Hospital Charge Code |
1412892
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$5,159.70 |
| Max. Negotiated Rate |
$9,687.60 |
| Rate for Payer: Aetna Commercial |
$9,477.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,055.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,580.90
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cigna Commercial |
$9,687.60
|
| Rate for Payer: Health EOS Commercial |
$9,371.70
|
| Rate for Payer: HFN Commercial |
$9,687.60
|
| Rate for Payer: Multiplan Commercial |
$8,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,318.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,687.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,159.70
|
| Rate for Payer: Quartz Commercial |
$6,318.00
|
| Rate for Payer: WEA Trust Commercial |
$5,791.50
|
| Rate for Payer: WPS Commercial |
$7,799.57
|
|
|
CV Angiogram Extremity Left
|
Facility
|
IP
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
1412894
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$6,708.10 |
| Max. Negotiated Rate |
$12,594.80 |
| Rate for Payer: Aetna Commercial |
$12,321.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,773.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,255.70
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$12,594.80
|
| Rate for Payer: Health EOS Commercial |
$12,184.10
|
| Rate for Payer: HFN Commercial |
$12,594.80
|
| Rate for Payer: Multiplan Commercial |
$10,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,214.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,594.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,708.10
|
| Rate for Payer: Quartz Commercial |
$8,214.00
|
| Rate for Payer: WEA Trust Commercial |
$7,529.50
|
| Rate for Payer: WPS Commercial |
$10,140.18
|
|
|
CV Angiogram Extremity Left
|
Professional
|
Both
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
1412894
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$6,023.60 |
| Max. Negotiated Rate |
$13,005.50 |
| Rate for Payer: Aetna Commercial |
$13,005.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,773.40
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$13,005.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,845.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,214.00
|
| Rate for Payer: Health EOS Commercial |
$12,457.90
|
| Rate for Payer: HFN Commercial |
$13,005.50
|
| Rate for Payer: Multiplan Commercial |
$10,952.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,005.50
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.60
|
| Rate for Payer: Quartz Commercial |
$7,803.30
|
| Rate for Payer: The Alliance Commercial |
$6,845.00
|
| Rate for Payer: WEA Trust Commercial |
$7,529.50
|
| Rate for Payer: WPS Commercial |
$10,140.18
|
|
|
CV Angiogram Extremity Left
|
Facility
|
OP
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
1412894
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$54,760.00 |
| Rate for Payer: Aetna Commercial |
$12,321.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,773.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,833.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,898.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,845.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,571.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,255.70
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$12,594.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,660.92
|
| Rate for Payer: Health EOS Commercial |
$12,184.10
|
| Rate for Payer: HFN Commercial |
$12,594.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,267.50
|
| Rate for Payer: Multiplan Commercial |
$10,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,214.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,594.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,708.10
|
| Rate for Payer: Quartz Commercial |
$8,898.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,214.00
|
| Rate for Payer: The Alliance Commercial |
$54,760.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$7,529.50
|
| Rate for Payer: WPS Commercial |
$10,140.18
|
|
|
CV Angiogram Extremity Right
|
Facility
|
OP
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 RT
|
| Hospital Charge Code |
2980127
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$42,120.00 |
| Rate for Payer: Aetna Commercial |
$9,477.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,055.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,948.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,580.90
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cigna Commercial |
$9,687.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,892.59
|
| Rate for Payer: Health EOS Commercial |
$9,371.70
|
| Rate for Payer: HFN Commercial |
$9,687.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,897.50
|
| Rate for Payer: Multiplan Commercial |
$8,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,318.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,687.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,159.70
|
| Rate for Payer: Quartz Commercial |
$6,844.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,318.00
|
| Rate for Payer: The Alliance Commercial |
$42,120.00
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$5,791.50
|
| Rate for Payer: WPS Commercial |
$7,799.57
|
|
|
CV Angiogram Extremity Right
|
Facility
|
IP
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 RT
|
| Hospital Charge Code |
2980127
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$5,159.70 |
| Max. Negotiated Rate |
$9,687.60 |
| Rate for Payer: Aetna Commercial |
$9,477.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,055.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,580.90
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cigna Commercial |
$9,687.60
|
| Rate for Payer: Health EOS Commercial |
$9,371.70
|
| Rate for Payer: HFN Commercial |
$9,687.60
|
| Rate for Payer: Multiplan Commercial |
$8,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,318.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,687.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,159.70
|
| Rate for Payer: Quartz Commercial |
$6,318.00
|
| Rate for Payer: WEA Trust Commercial |
$5,791.50
|
| Rate for Payer: WPS Commercial |
$7,799.57
|
|
|
CV Angiogram Extremity Right
|
Facility
|
IP
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
1412896
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$6,708.10 |
| Max. Negotiated Rate |
$12,594.80 |
| Rate for Payer: Aetna Commercial |
$12,321.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,773.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,255.70
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$12,594.80
|
| Rate for Payer: Health EOS Commercial |
$12,184.10
|
| Rate for Payer: HFN Commercial |
$12,594.80
|
| Rate for Payer: Multiplan Commercial |
$10,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,214.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,594.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,708.10
|
| Rate for Payer: Quartz Commercial |
$8,214.00
|
| Rate for Payer: WEA Trust Commercial |
$7,529.50
|
| Rate for Payer: WPS Commercial |
$10,140.18
|
|
|
CV Angiogram Extremity Right
|
Professional
|
Both
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 RT
|
| Hospital Charge Code |
2980127
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4,633.20 |
| Max. Negotiated Rate |
$10,003.50 |
| Rate for Payer: Aetna Commercial |
$10,003.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,055.80
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cigna Commercial |
$10,003.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,318.00
|
| Rate for Payer: Health EOS Commercial |
$9,582.30
|
| Rate for Payer: HFN Commercial |
$10,003.50
|
| Rate for Payer: Multiplan Commercial |
$8,424.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,003.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,633.20
|
| Rate for Payer: Quartz Commercial |
$6,002.10
|
| Rate for Payer: The Alliance Commercial |
$5,265.00
|
| Rate for Payer: WEA Trust Commercial |
$5,791.50
|
| Rate for Payer: WPS Commercial |
$7,799.57
|
|
|
CV Angiogram Extremity Right
|
Facility
|
OP
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
1412896
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$54,760.00 |
| Rate for Payer: Aetna Commercial |
$12,321.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,773.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,833.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,898.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,845.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,571.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,255.70
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$12,594.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,660.92
|
| Rate for Payer: Health EOS Commercial |
$12,184.10
|
| Rate for Payer: HFN Commercial |
$12,594.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,267.50
|
| Rate for Payer: Multiplan Commercial |
$10,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,214.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,594.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,708.10
|
| Rate for Payer: Quartz Commercial |
$8,898.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,214.00
|
| Rate for Payer: The Alliance Commercial |
$54,760.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$7,529.50
|
| Rate for Payer: WPS Commercial |
$10,140.18
|
|
|
CV Angiogram Extremity Right
|
Professional
|
Both
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
1412896
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$6,023.60 |
| Max. Negotiated Rate |
$13,005.50 |
| Rate for Payer: Aetna Commercial |
$13,005.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,773.40
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$13,005.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,845.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,214.00
|
| Rate for Payer: Health EOS Commercial |
$12,457.90
|
| Rate for Payer: HFN Commercial |
$13,005.50
|
| Rate for Payer: Multiplan Commercial |
$10,952.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,005.50
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.60
|
| Rate for Payer: Quartz Commercial |
$7,803.30
|
| Rate for Payer: The Alliance Commercial |
$6,845.00
|
| Rate for Payer: WEA Trust Commercial |
$7,529.50
|
| Rate for Payer: WPS Commercial |
$10,140.18
|
|
